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767 Jack Booe RdDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section�g �u P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 �Ia (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001366 Tax PIN/EH #: 5812-37-2689.04 Billed To: David Beckerman Subdivision Info: Reference Name: Mackie McDaniel Location/Address: Jack Booe Road -27028 Proposed Facility: Residence Property Size: see map ATC Nummber: 2571 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People Z #Bedrooms #Baths Dishwasher: 9( Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type #PPeoople #People/Shift /-#Seats Industrial Waste: El Lot Size 5 Q Type Water Supply ��N Design Wastewater Flow (GPD) -1 g0 Site: New Repair ❑ System Specifications: Tank Size IWO,-AL. Pump Tank GAL. Trench Width S Rock Depth Z Linear Ft.�� 1 Other: 1 S-FaA'30TI OA -f)0Y-l.S , INSTILL. L-1rNt .S O•C A&1,J Required Site Modifications/Conditions: cJS h►lY O+J TOS 1�1:-1=►' Is' �t"� Int l.GJa IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** 27 `CO3 IJVr�. �4f\1 Nffl2ox 1-35 ironmental Health Specialist's Signature: DCHD 05/99 (Revised) Its Fi[Er-nor-N 01 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001366 Tax PIN/EH #: 5812-37-2689.04 Billed To: David Beckerman Subdivision Info: Reference Name: Mackie McDaniel Location/Address: Jack Booe Road -27028 Proposed Facility: Residence Property Size: see map ATC Number: 2571 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS S VALI OR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: D e: %g GAJ CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. 18 -To A f:C,?-0z:2 10 3" Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Hooss I�� 3„x z to Date: AT t ••iSP�"t� APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & AFN�l'1 I5Davie County Health DepartmentEnvironments/Heia/thSec�t3on000 P.O. Box 848/210 Hospital StreetMocksville, NC 27028 (336)751-8760. HEALTH TY ***Z1MPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. (�Refe�r� to the INFORMATION BULLETIN for instructions. 1. Hama to be Billed (O(N*0 N( 13e.C� e -X/ A (%YJ contact Person MAA F� I E / • (`c l�o ti !sailing Address J I" �y Q��` U1-__ �g ) �f f Some Phone 33L' 5- +� / © ,0 City/state/ZIP (Ili �_fOt/) .�%�s\fi`�� /V ! Business Phone 2. Name on Permit/]ITC If Different than Above Mailing Address City/stag/Zip 3. Application For: ❑ Site Evaluation 0 Improvement Permit/ATC ((('Both 4. systen to service: (-House ❑ Mobile Home ❑ Business 0 Indus 0 Other 5. If Re Bence: # People # Bedrooms # Bathrooms • 5 Dishwasher O Garbage Disposal LT leashing Machine 6Y Basemeat/plumbing O Basement/No Plumbing 6. If Business/Industry/Other: specify type # People # Sinks # Commodes # showers # Urinals # water Coolers IS FOODSERVICE: $ Seats Estimated Water Usage (gallons per day) 7. Type of water supply: i3-c-ounty/City O Well ❑ Community s Do you anticipate additions or expansions of the facility this system is Intended to serve? ❑ Yes 0 No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensiods:363 g Q 111.19X illi -5 7XZ QJ- WRITE DIRECTIONS (from M//ocksville) to PROPERTY: Tax OfticePIN: #5.911 2 t L9 r 0y /�0/ 1)n,2{�L-'fDL�/ &A7 -5-c C w Property Address: Road Name J PtC..�C i� e �a City/Zip K.t7oVs of ((e— No., If in a Subdivision provide information, as follows: Name: Section: Block: Lot: Date Property Flagged: X- --Iq - t9 y This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation, If the site, plans or intended use change, or If the Information submitted in this application is falsified or changed I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County ealth epartment to enter upon above described property located in Davie County and owned byi= to conduct all testing procedures as necessary to determine the site suitability. /J "o, DATE &-,- r 7— C;> C) THIS AREA MAY BE USED FOR DRAWIN ud oll of the following: Existing and property lines and djT±nsiqusrst c ures, setbacks, and septic locations). ,'_, WAI Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS• Account No. t 3 (0 Invoice No. i VJ) Ml M l ww Me ;S C:v ,)A 74 2 1, W, al 4 r -f V� -5 ire ox cn 7 Ac 7 Zf JJO. "RA) PD C4 Brar) _h IRS .37,9.,34, IRS 2002. -"414.87- -97' Toto! N B6.39 w 52' artmot TO* Lo p Tom f a'40 -542 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5812-37-2689, 051 Subdivision Info: Location/Address: Jack Booe Road -270 4 see map Date Evaluated: /� APPLICANT INFORMATION Account #: 990001366 Billed To: David Beckerman Reference Name: Mackie McDaniel Proposed Facility: Residence Property. Size: Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L- C� Slo % HORIZON I DEPTH 0 -17 - Texture group !Fc- L_ Consistence M Structure j Mineralogy 1 , t HORIZON II DEPTH t2 Texture groupG Consistence ` Structure Mineralogy HORIZON III DEPTH 5 `� Texture group Consistence S ` Structure 1� , Mineralogy fynv_av HORIZON IV DEPTH _"X60 Texture group3 Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE p , SITE CLASSIFICATION: t' J LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: OTHER(S) PRESENT: y, D ►d�C.�� R"" � ,A �a LEGEND Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC -Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very friable, FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) ON ON no ■■ ■■ ■■ ■■ ON i i i ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■e■■■■■■■■■■ecce■■■■■eeeeel�l■e■■ee■■■■■■■■■■ee■■■ee■■e■■e■e■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ecce■■■■■■■eee■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ecce■■■eee■■■e■■■■■■■■eee■■■■■■■■■■■■■■■ee■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■a■eee■■■■■eee■■■■e■■■e■■e■■■■■■■■■■■■■■■■e■■eeeee■■■■■■■■ ■e■■■■■■■■■■■eeeee■■■■■■s■■■e■■■■■■■■■■■■■■■■■■e■■■■■■■ecce■ ■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■eeeee■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■ecce■■■■■■■■■■■■ ■■■■■■■■■■■■eee■■■■■■■■■■■1�1■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■e■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■eee■■■■■■■■■■■■■■■■■■■e■■■■■■■■c■■■■ ■■eee■eeeeeee■■■■ee■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■e■■■e■■■eeeee■e■■■e■■■■■■■■e■■■e■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■e■eee■■■■■■I�1■■■■■■es■■■■■■e■■■■■■■■■■■■■■■■■ ■■■■■■■e■■■■■■■■■■■■■■■■■eee■■■■■■■o■■■■■■■��i■■■e■s■■■e■■■■■ ■■■■■■■■■■■eeeeeest■■■■■■rni■eel�■■■• ��■■���■■■11■■■■■■■s■■■■■■■ ■■■■11■■■■■■■::::::::./■■■a■■■eeeee■■■IIe■■■■■■■■■s■■■■ MENEMEMMONSiiiiii'�iMEMNONMEMNON11MMEMiMENNEN ■■■■II■■e■■■e■■■■■■■■eeeee■■■e■■■■■■■■■■11■e■■ee■e■■■■■■■ ■■■■Ilt■■■■■eeee■■■■■eeee■■■■e■■■■■■■■■■11■■■■e■■e■■■■■■■ ■e■■11■■■■■■s■■■■■■■■e■■eee■■■■■■■■■■■■elle■■■■e■■■■■■■■■ ■■■■■■■■■11■eeee■■■■■■i■■■■■■ei■■■■■■■■eeeee■■■II■■■■■■■■■■■■■■■ ■■■■■■e■■Ile■■■■■■■■■■i■rll�Tcai■■■■■■■■e■e■■■s■11■■■■■■■■■■■/■■■ ■■■■■■■■■II■■■■■■■■■■■i■■LS�ifii■i■eee■■■■■■■■■■■■i■■■■■■■■■■■■■■■■ ■■■■■■■■■11■■■■■■■■■■■lees■■■■t■■■■■■eeeeeee■■■I■■■■■■■■■■■■■■■■ ■■■■■■eee11■■■■■■■■■■�Y/■■■�■eeee■■■■■eee■■■11■■■■■■■■■■■■■■■ ■■■■eee■■Ile■■■■■■■■■►.S%7■■■ ■■■■■■■■eeee■■■■1■■■■■■■■■■■■■e■■ ■■■eeee■■Ilea■■■■■■■■■■a'■��[�■■■■■■■■■■■■■■■■■1■■■■■■■■■■■■■■■■ ■■■■■■■■■11■■■■■■■■■■■■■■■■■��1X17■■■■■■■■■■■■II■■■■■■■■■■■■■e■ ■■■ee■■■■11■■■■■■■■■■■eeeeeee■�/ifr7■■eee■■■■■■ell■■■■■■■■■■■■■■■ ■eee■■■■■11■■■■■■■eee■■■■■eeeee■■■■■■■■■■■■■■II■■■■■■■eee■■■■■ ■■■■■■■■■11■■eeee■■■■■■■■eee■■■■■■■■■■■■■e■■■II■■■■■■■eeee■■■■ ■■■■■■■■■Ile■■■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■11■■■■■eee■■■■■e■ ■■■■■■■■■11■eee■■■■■■■■■■■■■■■■■■■ee■■■■e■■■■11■■■■■■■e■■■■■■■ ■■■■■■■■■II■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■Ile■■■■■e■■■■■■e■ ■■■■■■■■■11■■■■■■■■■■■■■■■ell■a■■■c■■■■■c■■■■11■■■■■■■■■■■■■■■ ■■■■■■■■■II■■■ee■s■eee■■■■■■■■■■ee■■■■■■■■■■■II■■■■■■■■e■■■■■■ ■e■■■e■■■II■■■eeee■■■■■■■■■■■■■■■e■■■■■■■■■■■II■■e■■■■■■■■■■■■ ■■■■■■■o■II■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■e■■elle■■■■■■■■■■■■■■ ■■eee■■■ell■■■eeeeee■■■■■■■■■■■■■■■■■■■■■■■■elle■■■■■■■■■eeee■ Davle County Aealth Department Environmental )Yealth Sectlon Po Box 848 / 210 Hospital street Mocksville, NC 27028 Phone. (336)751-8760 September 18, 2000 Mr. David Beckerman 3120 Myrtle Drive Winston-Salem, NC 27107 Re: Site Evaluation - 5.007 Acre Tract/Jack Booe Road Tax PIN #: 5812-37-2689 Dear Mr. Beckerman: As requested, a representative from this office visited the above site on September 14, 2000. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system Due to complex topography and poor soil conditions over much of this tract, the area for the septic system is limited. The southeastern back corner of the property should be reserved for the installation of the septic system Its elevation will probably necessitate a pump station. Further clearing and evaluation of the front of the tract(Jack Booe Road) may reveal sufficient space and soil conditions to allow the septic system to be installed in this area. However, based on the proposed house location and current site evaluation, a pump will be required. Actual design and dimensions of the septic drain field will be determined at the time an improvement permit is issued. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at (336)751-8760. Sincerely, Jeff G. Beauchamp, R.S. Environmental Health Section DAVIE COUNTY HEALTH DEPARTMENT �st `l' �-�-" ° Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001366 Tax PIN/EH M 5812-37-2689.04 Billed To: David Beckerman Subdivision Info: Reference Name: Mackie McDaniel Location/Address: Jack Booe Road -27028 Proposed Facility: Residence Property Size: see map **NOT *NThiseimproveement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type jr'COF:'� #People 7 #Bedrooms q #Baths :7— Dishwasher: Iff/ Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: a Basement/No Plumbing: ❑ Commercial Specification: Facility Type n #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 5�'��p0ype Water Supply CVGI �i Design Wastewater Flow (GPD) 422 Site: New e Repair ❑ 01 System Specifications: Tank Size/CWGAL. Pump Tank GAL. Trench Width Rock Depth �Z Linear Ft. -19R>' Other: ��Q�l'.7! %l0� . lige C,%nJL % d C fit .j Required Site Modifications/Conditions: 157' egr /)WS IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 G° BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** X ra LI&Z noose is' Environmental Health Specialist's Signature: F-V-O,,j r / a/12 12'W IF APPQOK. DCHD 05/99 (Revised�.PPapx • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001366 Billed To: David Beckerman Reference Name: Mackie McDaniel Proposed Facility: Residence ATC Number: 2571 Tax PIN/EH #: 5812-37-2689.04 Subdivision Info: Location/Address: Jack Booe Road -27028 Property Size: see map AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s): This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and isposal Systems). THIS AUTHORIZATION FOR WASTEWATER C R TI S VALID F RIOD OF FIVE YEARS. Environmental Health Specialist's Signature: a CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMFF & ATC Davie County Health Department Environmental Health Seaon P.O. Box 848/210 Hospital.Street Mocksville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to th/�e_-INFORMATION BULLETIN for instructions. 1. Name to be Billed 1 AV 1� aPMA Contact Person M4`.KI� AODA-. Mailing Address "IlL'1 Noss Phone City/stats/LSP L\) -S oC. Z^) it7, Busiasso Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/Stats/Lip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC B Both 4. system to service: W/ House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other s. If Residence: # People # Bedrooms 4 f Bathrooms 1- V Dishnasher ❑ Garbage Disposal C/ hashing Machine O Baseaent/Pluebing O Basement/No Plumbing 6. If Business/Sndustry/Other: specify type # Conmodes # showers IF FOODSERVICE: # Seats # Urinals # People # sinks # hater Coolers Estimated Water Usage (gallons per day) 7. Type of hater supply: 2(-County/city 111101A 9. Do you anticipate additions or expansions of the facility this system Is intended to serve? If yes, what type? ❑ Community ❑ Yes ❑ No ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: J• 0aS- {CA'"$ WRITE DIRECTIONS (from Mocbviue) to PROPERTY: Tax Office PIN: # ,&e-- (ver /� —M Cl4C*— Property Address: Road Name c A % zz i t > City/Zips l �� UIn a Subdivision provide Information, as follows: Name: Section: Block: Lot: Date Property Flagged: This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation, lithe site plans or intended use change, or if the information submitted in this application is falsified or changed I, also, understand that I ant responsible for all charges incurred from this application. I, hereby; give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by #06AA UIA - to conduct all testing procedures as necessary to determine the site suitability. � DATE SIGNATURE i a ` " -s-r THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: I EHS: Revised DCHD (07/99) Account No. Invoice No. 17 12 P °° kj 'Lbw r :: PKj-Nail. ptgcstt t X. r• `>., t+� ♦ w r _ Vi. 'T/'^�iij .� rr i�t i iiiIQQJ` L�2t .�Z#j srj.. .-P..►�'" 'uns� to M � a 1 Point u�! i //��� a y Y0 = wx a y sx w: t r ((/.�/► y d�,$j y .. '.. { i t Af }F '} i.fi.t fg• L 1 h` _ „•. .� 5 kf ?•i. St ',�hiyy !. L � _ � -. 'i � � �����Y�f�,s,A ��� t b�` .,� J � ��y �Wos•f•� '�F° �t+ (GrC(udes Mei 74fti�Wfi WO, t (Incltidss'Artilc w,thln sR=1330 (#1`MYj ri y K" tx Q Brmich IRS 379.34' IRS i 414.87• IRS 2002.97' Total / N 660.39#52-W .. Tax Cot 35 TfAW02 , Jarna R t 09 140.'f PQ 542 DAVIE COUNTY HEALTH DEPARTMENT ~ Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001366 Tax PIN/EH #: 5812-37-2689.04 Billed To: David Beckerman Subdivision Info: Reference Name: Mackie McDaniel Location/Address: Jack Booe Road -27028/ Proposed Facility: Residence Property Size: see map Date Evaluated: `�/ �`� 0� Water Supply: On -Site Well Evaluation By: Auger Boring Community Pit Public Cut FACTORS 1 2 5 6 7 Landscape position L_ l tit Slope % OTT - HORIZON I DEPTH D _ n Texture group 3c4— Consistence FSS Structure Ca a- MineralogyM1 HORIZON II DEPTH I — 1 Texture group Consistence !V ; Structure S iL Mineralogy1 HORIZON III DEPTH 10—L40 Texture groupI Consistence ; Fi Structure - It Mineralogy t V --t HORIZON IV DEPTH 440 Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: f 4� LONG-TERM ACCEPTANCE RATE: 0.5 REMARKS: EVALUATION BY: S;T t&it✓�w"ZP OTHER(S) PRESENT: ` `� ,4J DWJ- INIA19 54SeJ-A-J LEGEND Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) ■ ■ ■ NEON MEMO SEEN OMEN SEEN ■■■■ ■M■■ NONE ■■N■ ■■N■ MEMO ■ ■■■■■■■■■■■■■■■■■■■■■ ■■M■■■■■■■■■■■■■ ONE ■■■■■■M■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■M■■S■■■■■■M■M■■1U■■■ ■■■MEMO■■S■■■E■■ ■■■ ■■■■■ OMENS ■M■■■ MEMOS ■■M■■ ■■■M■ ■EM■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■■■■■Iliiriii."'.!�■■ NONE ■■■■■■MOM■■■E■ ■M■■■■■■■■E■E■ ■■■■■■MESE■■■■ ■■■■■■■■■■■■■■ ME■■■M■■M■■■E■ ■■■■■■■■■■■■■■ EME■■■EE■■■■■■ ■■■■E■■■■■■■■■ ME■■■■MEM■ME■■ ■■■■■■■■■■■■M■ ■ME■■■■■■■■■■■ ■■■■■■■■■■■■■■ ■■■■■■■E■■■E■■ ■■■■■■■■■11■■■■■■■■■■■ISA■■■■■■�■■■■■■■� ■■■iiiiiiiiii ■■■■■11■E■■■■ ■■■■■11■■■■■■ ■■MM■11■■M■■M ■■■■■11■■■MM■ ■E■■■11■■■e■■ ■EM■M11■■M■M■ ■■■■■11■■■■■■ M■■■■11■■■■■■ ■■M■■11■■■■■■ ■■M■M11M■■■M■ ■■■■■IIN■■■■■ on No